Pressure bandages rather than tourniquets should be applied in the case of minor bleeding from open wounds in extremity injuries. When uncontrolled arterial bleeding occurs from mangled extremity injuries, including penetrating or blast injuries or traumatic amputations, a tourniquet represents a simple and efficient method to acutely control haemorrhage [27-31]. Several publications from military settings report the effectiveness of tourniquets in this specific setting [27-30]. A study of volunteers showed that any tourniquet device presently on the market works efficiently [31]. The study also showed that ‘pressure point control’ was ineffective because collateral circulation was observed within seconds. Tourniquet-induced pain was not an important consideration.Tourniquets should be left in place until surgical control of bleeding is achieved [28,30]; however, this time-span should be kept as short as possible. Improper or prolonged placement of a tourniquet can lead to complications such as nerve paralysis and limb ischaemia [32]. Some publications suggest a maximum time of application of two hours [32]. Reports from military settings report cases in which tourniquets have remained in place for up to six hours with survival of the extremity [28].II. Diagnosis and monitoring of bleedingInitial assessmentRecommendation 3 We recommend that the physician clinically assess the extent of traumatic haemorrhage using a combination of mechanism of injury, patient physiology, anatomical injury pattern and the patient’s response to initial resuscitation (Grade 1C).Rationale The mechanism of injury represents an important screening tool to identify patients at risk for significant traumatic haemorrhage. For example, the American College of Surgeons defined a threshold of 6 m (20 ft) as a ‘critical falling height’ associated with major injuries [33]. Further critical mechanisms include blunt versus penetrating trauma, high-energy deceleration impact, low-velocity versus high-velocity gunshot injuries, etc. The mechanism of injury in conjunction with injury severity, as defined by trauma scoring systems, and the patient’s physiological presentation and response to resuscitation should further guide the decision to initiate early surgical bleeding control as outlined in the ATLS protocol [34-37]. Table Table22 summarises estimated blood loss based on intitial presentation. Table Table33 characterises the three types of response to initial fluid resuscitation, whereby the transient responders and the non-responders are candidates for immediate surgical bleeding control.